NSQIP versus institutional morbidity and mortality conference: complementary complication reporting in pediatric spine f
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NSQIP versus institutional morbidity and mortality conference: complementary complication reporting in pediatric spine fusion Sebastian E. Welling1 · Cindy B. Katz2 · Michael J. Goldberg3 · Jennifer M. Bauer3 Received: 8 April 2020 / Accepted: 25 August 2020 © Scoliosis Research Society 2020
Abstract Purpose Other fields of medicine have demonstrated underreported surgical complication rates by institutional M&M compared to NSQIP. However, a study comparing surgical complication rates in the pediatric spine population, using an identical set of patients rather than nationally extrapolated, has not been performed. Methods A single institution’s ASC-NSQIP Pediatric spine fusion cases and its departmental team-reported M&M database for the same were reviewed for January 1, 2012 to December 31, 2018. Differences in surgical complication reporting between the two databases for the identical patient cohort were recorded. Results NSQIP identified 50 pediatric spine fusion patients with complications out of 386 NSQIP-algorithm-sampled cases (13%). Of these complications, 23 were not reported in the M&M conference database (6% of NSQIP-sampled cases, 2.5% of all M&M cases). The most common under-reported complication categories include pneumonia (100% under-reported), clostridium difficile (100%), urinary tract infection (83%), and superficial wound disruption (67%). During the same 7 years, M&M covered 924 spine fusions and identified 162 complications. Of these 162 patients, 22 were included in the NSQIP sampling and were not reported as complications (6% of NSQIP sampled patients). Conclusion Recognizing complication rates is central to implement strategies for delivering better quality care. NSQIP data may serve as an important quality check for pediatric spine institutional M&M data, but both may not include all complications even within its sampled patients. In general, NSQIP’s protocols identified more medical complications, while M&M has a surgical focus, benefits from the limitless follow-up, and involves timely departmental awareness of complications. Keywords Scoliosis complications · Pediatric spine · Post-op spine fusion complications · M&m · NSQIP spine
Introduction Several surgical complication-tracking programs exist. Morbidity and mortality (M&M) conferences have long been used by individual institutions to identify complications with the goal of implementing change to prevent future adverse events [1, 2]. At our institution, the M&M database is fed by anonymous reporting by any member of the care team * Jennifer M. Bauer [email protected] 1
University of Washington School of Medicine, Seattle, WA, USA
2
Seattle Children’s Hospital, Seattle, WA, USA
3
Department of Orthopaedic Surgery, Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
including trainees, at any post-operative time point, including every surgery done, and reviewed monthly with complication
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